Retrospective Study of Relationship of Postpartum Depression to Planned Versus Emergent Cesarean Section

The purpose of this retrospective study is to determine if there is an increase in postpartum depression (PPD) among women who undergo an emergency cesarean section as opposed to a planned cesarean section. All previous research documenting the rate of PPD in cesarean section patients looks only at the incidence of PPD in cesarean section versus vaginal delivery, and does not separate emergent versus planned cesarean section. The general study hypothesis is as follows: An emergent cesarean section can be an emotionally traumatic experience. Women who have a cesarean section for emergent causes are not psychologically prepared for surgery, and thus experience an increased rate of PPD. The null hypothesis is: There is no significant difference in the rate of PPD among women who have a cesarean section for emergent causes versus women who have their cesarean section at the previously scheduled time.

Postpartum depression (PPD) is diagnosed in approximately 10-20% of women (DSM-IV-TR), and 25% of these women still suffer from PPD twelve months after delivery (Gregoire et al, 1996). Risks for developing PPD include a higher subjective burden of childbirth, poor relationship with spouse, significant other, or father of the baby, unemployment or dissatisfaction with job, and low socioeconomic status.

Obstetrical history risk factors include previous abortions, high-risk pregnancy, low birth weight, and cesarean section (Bergant et al, 1998).

Delivery via cesarean section (CS) creates a much different emotional experience than does a vaginal delivery. Disappointment in the ability to have a natural birth, feelings of resentment towards the physician, altered treatment expectation, as well as, pain and trauma associated with surgery are all contributing factors (Al-Nuaim, 2004). A majority of women consider an emergency cesarean section (CS) to be a mentally traumatic encounter. One third of women who require an emergency CS will experience posttraumatic stress reactions during the postpartum period (Ryding et al, 1997). Fisher et al reported that there is a significant relationship between mode of delivery and negative psychological outcomes. A mother who has a CS instead of a vaginal delivery is more likely to have mood deterioration, lowered self-esteem, grief reaction, posttraumatic distress, and depression (Fisher et al, 1997).

We propose to analyze the hospital and clinic medical records of 200 postpartum women who delivered by cesarean section (CS) at Tulsa Regional Medical Center between January 1, 2003, and June 1, 2005, and who obtained their postpartum care at the OSU Ob/Gyn Clinic in Tulsa, Oklahoma. Of the charts reviewed, 100 women will have had a CS for emergent causes, and the other 100 will have delivered via a planned CS.